The Singapore Medical Council (SMC) has called out the lack of guidance in disciplinary proceedings for doctors, adding a new guideline may be needed.

Following a doctor’s hearing last week, the disciplinary tribunal convened by the Singapore Medical Council (SMC) has called out for improved disciplinary proceedings against doctors. The council has stated that the current system suffers from “a lack of guidance” further adding that the council may form its own set of guidelines to ensure sentences meted out are consistent.

Actions towards improved disciplinary proceedings

For many doctors, the weight of suspension is a very heavy one, as it signifies an end to a lifelong career. Suspensions imposed may occur either due to a single error or multiple infractions showing no clear signs of consistency in punishment.

This situation is recognised by the disciplinary tribunal stating in its Grounds of Decision media release: “It appeared to us, throughout the course of these proceedings, that there was a lack of guidance in Singapore as regards (to) the sentencing of doctors in disciplinary proceedings.”

“Different sanctions have different consequences on the public and on the medical practitioner. It is therefore important for there to be guidance based on case precedents and policy considerations so that medical practitioners may be aware of the severity of their misconduct.”

Professor Walter Tan, the tribunal chairman, added, “This will also ensure that sentences meted out by the disciplinary tribunals and courts are consistent with how the medical profession perceives instances of professional misconduct.”

Ms Joan Pereira, a member of the Government Parliamentary Committee for Health, has also voiced her support on grounds that guidelines would “promote consistency in the treatment of doctors”. She added that “should there be any proven transgressions on the part of individual members, our society would want to see that the appropriate penalties are meted out.”

The tribunal has pointed towards the UK for establishing such guidance which has set out the rationale underlying each sanction and the broad factors which may lead to the imposition of each sanction. The UK Sanctions Guidance was developed by a steering group of tribunals and General Medical Council staff.

Precedence to change

This stark call for action comes after a recent incident which witnessed a general practitioner in Bedok being slapped with a fine of SGD30,000 for failing to refer a patient for specialist care “in a timely manner”. The patient who was suffering from a corneal ulcer did not seek further medical treatment (surgery) until later resulting in blindness in one eye.

Singapore general practitioner, Dr Sim Kwang Soon was fined SGD30,000 for his failure to refer his patient in a timely manner.

The general practitioner in question, Dr Sim Kwang Soon, openly admitted that his failure to refer his patient to an eye specialist “in a timely manner” constituted a breach of SMC’s Ethical Code and Ethical Guidelines (2002). The section of the guidelines that Dr Sim failed to adhere to stated, “A doctor should practise within the limits of his own competence in managing a patient. Where he believes that this is exceeded, he shall offer to refer the patient to another doctor with the necessary expertise.”

Ultimately, the tribunal did not suspend Dr Sim’s license to practise owing in part due to his service record and willingness to admit his faults early on in the hearing.

According to the tribunal, “there was insufficient evidence to show that the harm caused to the patient was due to Dr Sim’s failure to refer her to a specialist (in a timely manner)… The (tribunal) also considered and gave full credit to Dr Sim for pleading guilty at an early stage, for his long good standing in the medical profession, and the good testimonials tendered on his behalf.”

Standing by its decision, the disciplinary tribunal, in its report listed several facts that were considered when determining whether a suspension should have been imposed. The disciplinary tribunal stated that “a suspension order would generally be imposed if one or more of the following factors are present: serious and direct breach of the relevant rules and/or statutory provisions; negative consequences, including any pain and/or harm caused to the patient(s); and/or elements of dishonesty.”

The disciplinary tribunal also noted that there were “broad factors” and a “spectrum of gravity” which made the case unique. Even in the past, there have been “exceptional circumstances” which resulted in the Courts/Tribunal abstaining from imposing suspension orders.

The bottom line

Imposing a suspension is never an easy matter, be it towards the doctor who receives it or the disciplinary tribunal/courts which deems it necessary. Most recently, Dr Sim’s case was a clear reminder that errors are not often so ‘clear cut’. The country, which currently lacks a Sanctions Guideline, has now been urged by the SMC to develop one – for the purpose of ensuring consistent sentences for all future medico-legal cases. MIMS